MEDICARE: MASON BERYL COLLINS FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AP135101	TX

General Provider Information

NPI Number	:	1053830562
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MASON BERYL COLLINS FNP

Provider Business Mailing Address
First Line	:	2021 W BEAUREGARD AVE
Second Line	:
City	:	SAN ANGELO
State	:	TX
Zip	:	76901-3812
Country	:	US
Telephone Number	:	325-777-0737
Fax Number	:	617-604-2536

Provider Business Practice Location Address
First Line	:	2021 W BEAUREGARD AVE
Second Line	:
City	:	SAN ANGELO
State	:	TX
Zip	:	76901-3812
Country	:	US
Telephone Number	:	325-777-0737
Fax Number	:	617-604-2536

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2017
Last Update Date	:	05/06/2024

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